Cost-effectiveness analysis of intensity modulated radiation therapy versus 3-dimensional conformal radiation therapy for anal cancer

Joseph C. Hodges, Muhammad S. Beg, Prajnan Das, Jeffrey Meyer

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose To compare the cost-effectiveness of intensity modulated radiation therapy (IMRT) and 3-dimensional conformal radiation therapy (3D-CRT) for anal cancer and determine disease, patient, and treatment parameters that influence the result. Methods and Materials A Markov decision model was designed with the various disease states for the base case of a 65-year-old patient with anal cancer treated with either IMRT or 3D-CRT and concurrent chemotherapy. Health states accounting for rates of local failure, colostomy failure, treatment breaks, patient prognosis, acute and late toxicities, and the utility of toxicities were informed by existing literature and analyzed with deterministic and probabilistic sensitivity analysis. Results In the base case, mean costs and quality-adjusted life expectancy in years (QALY) for IMRT and 3D-CRT were $32,291 (4.81) and $28,444 (4.78), respectively, resulting in an incremental cost-effectiveness ratio of $128,233/QALY for IMRT compared with 3D-CRT. Probabilistic sensitivity analysis found that IMRT was cost-effective in 22%, 47%, and 65% of iterations at willingness-to-pay thresholds of $50,000, $100,000, and $150,000 per QALY, respectively. Conclusions In our base model, IMRT was a cost-ineffective strategy despite the reduced acute treatment toxicities and their associated costs of management. The model outcome was sensitive to variations in local and colostomy failure rates, as well as patient-reported utilities relating to acute toxicities.

Original languageEnglish (US)
Pages (from-to)773-783
Number of pages11
JournalInternational Journal of Radiation Oncology Biology Physics
Volume89
Issue number4
DOIs
StatePublished - Jul 15 2014

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Anus Neoplasms
cost effectiveness
Cost-Benefit Analysis
radiation therapy
Radiotherapy
cancer
toxicity
Life Expectancy
costs
Costs and Cost Analysis
Colostomy
Quality of Life
sensitivity analysis
prognosis
chemotherapy
Treatment Failure
health
iteration

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Cost-effectiveness analysis of intensity modulated radiation therapy versus 3-dimensional conformal radiation therapy for anal cancer. / Hodges, Joseph C.; Beg, Muhammad S.; Das, Prajnan; Meyer, Jeffrey.

In: International Journal of Radiation Oncology Biology Physics, Vol. 89, No. 4, 15.07.2014, p. 773-783.

Research output: Contribution to journalArticle

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